Febrile seizure? Time to cool off your child

What is a Febrile Seizure:

Febrile seizures, or commonly know as fever fits, are common. Up to 4 % of children throw fits during a febrile episode. Febrile seizures are commonly seen in age group 6 months to 6 years of age. It is a very frightening experience for any parent to witness his little one seizing. But most febrile seizures are harmless.

Febrile seizure is not same as epilepsy. Epilepsy [Seizure disorder, also called as Mirgi or Apasmar in India] is repeated seizures, that are unrelated to fever. Epilepsy is treatable, though it requires medications for a prolonged duration.

The exact cause for fever fits is unknown, but they are known to run in families. Fever is usually triggered by any infection like common cold or a diarrhea, and the child can throw a seizure at the height of fever. This seizure is usually self limiting, subsides within a few seconds/ minutes [usually less than 10 min] and child regains consciousness soon after.


Do these seizures tend to recur?

In up to 30-50% chances, these seizures may recur with fever. A positive family history, younger age [less than a year] makes a child prone for recurrent febrile seizure. Usually children out grow their febrile seizure by the age of 5-6 years. In rare instances, if there are more than one febrile seizure in a day, or the fits occur only in some one part of the body, there is a risk of developing epilepsy.

Do they have any effect on child's brain?

In most instances, these febrile seizures last for a few seconds, do not recur within 24hrs. Such simple febrile seizures are benign in nature, and these children do not develop epilepsy or have any long term effects on their brain development.

What is meningitis?

Meningitis is a serious condition. Its the infection of brain and its surroundings. Meningitis can also present with fever and seizures, just like febrile seizure, but children with meningitis are usually sicker and have other symptoms like poor feeding, lethargy and vomiting.
In case of fever and seizure you need to rush hospital immediately if:

• Your child is less than 6 months of age
• Not feeding properly
• Excessively sleepy
• Headache/ neck pain
• Purple rash anywhere on the skin
• first time fever with seizure

What is the treatment for febrile seizure?

Before starting treatment, many a times treating physicians may have to perform certain blood tests and lumbar puncture to confirm that the child is not suffering from meningitis, as both conditions can present in similar fashion. Lumbar puncture, when performed under expert hands, is a safe procedure, and does not have any effect on child's spine/ walking.

Febrile seizure usually does not need any extra treatment other that control of fever. An anti-seizure medication [eg. Frisium] may be prescribed for a short duration of 3-5 days, but there is usually no need for long term anti-seizure medications. Antibiotics are usually given if the cause of fever is bacterial throat/ ear/ urinary infection.

What the parents can do at home:

In a known case of febrile seizure, parents can start with fever medications as soon as the child gets a fever anytime above 100.4*F [38*C]. The temperature can be measured in the armpit and not necessarily in the mouth. One should avoid using the mercury thermometer in mouth as there is risk of biting & breaking the thermometer. It is a good idea to have a prescription of paracetamol [same as Crocin / Calpol/ PCM] with the dosage written from your pediatrician. Paracetamol is a safe drug and can be safely given up to 4-5 times in a day for the control of fever. Various drugs like Aspirin/ Nimesulide are harmful in children, and are best avoided. Wet sponging the whole body [not just forehead] is sometimes helpful in bringing down the fever, if its too high.

Despite adequate control of fever, child may throw a seizure. In such case, place the child on a safe place to avoid injury. Remove any tight clothing/ jewelery around the neck and place the child in lateral position. Make sure the airway is open, do not splash water on face [a common but dangerous custom in India]. A rectal suppository [soft tablet to be inserted in to the anus] or nasal spray of anti-seizure medications are available on prescription, and can be used during such episode to control the seizures. Consult your pediatrician and keep this medications handy, stored in refrigerator. After the fits have subsided, do not immediately feed the child.

Always visit your pediatrician after any episode of fever with seizure to make sure it isn't something other than a febrile seizure.

Pediatric Second Opinion: Knowing your child's disease better

Pediatric Second Opinion: Knowing your child's disease better: "Many times parents are unaware of the health condition of these child. Especially in country like India, a proper communication between pare..."

A hole in the heart.

Many times parents are unaware of the health condition of these child. Especially in country like India, a proper communication between parents and treating physician is lacking. This may be due to lack of time or lack of a proper rapport with the doctor. Too much of information or use of lots of technical terms can sometimes leaves parents confused. Parents need to get the right information, not only because its there right,  but because it helps them to get an idea about the severity, progress and the likely outcome of the disease.

In this blog, We are trying to deliver the right information in simple words,so that parents from all educational backgrounds can understand their child's condition.

Stating this  blog with a common heart condition diagnosed in children.

A hole in the heart: congenital heart disease.

Yesterday I saw my colleague nurse saddened and worried about her nephew. Apparently her nephew was diagnosed to have "a hole in the heart". She broke into tears while mentioning about the parents getting worried and quite concerned about their kid. What amazed me was, the parents knew nothing except that there was "a hole in the heart" of their child.

The heart, while developing inside a fetus, is made up of tiny tubes. These tubes are made up of muscle fibres, and after a series of events, finally develop into 4 chambers, 2 atria [pleural for atrium]and 2 ventricles. There is a hole in the heart in all of our hearts at some point of development. These holes are present in the partition between the two chambers of the heart[between two atria or ventricles]. Some of these holes disappear early in fetal life while others get closed soon after birth. If the hole continues to be there after birth, its called as a septal defect.

These defects allow shunting of blood between the chambers up to a variable extent, depending upon the size and pressures. A smaller defect doesn't allow much of a shunting but creates loud noise, which is heard on the chest as a "murmur". A large defect causes a lot of shunting and mixing of blood, thus can lead to increased pressure in the lungs.

Many of these defects are innocent, get detected on general check-ups and need no treatment except for wait-and-watch for spontaneous closure, which usually happens by 3-4 years of age.

If it fails to get closed or the size is moderate, child can be operated electively with almost 100% success rate.

In case the defect is large, child may suffer from repeated chest infections and fails to grow properly. These children need medical therapy to prevent the heart from failing. The medical management is usually a time-buyer, till the definitive surgery is planned. Most of the large defects are correctable after surgery, and these children can lead a normal healthy life after surgery.

There are few forms of septal defects associated with bluishness of lips and nails. These are complex heart diseases, called as cyanotic congenital heart diseases. In such diseases, the septal defects are actually helpful for the survival of the child as they allow mixing and keep some oxygen rich blood flowing to the vital organs like brain.

If you are the parent with a child diagnosed with a "hole in heart", don't get unduly alarmed or depressed. Find an opportunity to discuss with doctor the nature and the size of the defect. Discuss the treatment options medical and surgical. Its a good idea to discuss the tentative timing and expenses of the surgery so that you can plan your things accordingly. Doctor may not be able to give you exact percentage but always discuss the quality of life the child will have after a corrective surgery, especially if he/she has other ailments along with heart disease, for example a stroke or neurological impairment. Its very important to protect such children from common infections by observing hygienic measures. Ensuring adequate diet, iron supplements in the prescribed doses and additional vaccines to prevent infections are the minimum that you should do for your child.

Never lose hope if your child is detected to have a "hole in the heart", as most of them are curable.

Post your queries and we will try to solve them

Hello,

This blog is dedicated to those parents whose children are sick and undergoing medical treatment.
Such parents could post their queries regarding their child's health condition or the treatment options.

We are practicing doctors from India, trying to help parents from India and abroad who want an expert second opinion on their child's health condition.